Bekalu Chekol ^1* Sally Dijkerman ^2* Valerie Acre ² Sarah McCaffrey ³ Demeke D. Biru ¹ Abiyot B. Mehary ¹ Samuel M. Wolelaw ⁴

• ¹ Ipas Ethiopia, Addis Ababa, Ethiopia
• ² Ipas (United States), Chapel Hill, North Carolina, United States
• ³ Mailman School of Public Health, Columbia University, New York City, New York, United States
• ⁴ The Ohio State University Global One Health LLC, Eastern Africa Regional Office, Addis Ababa, Ethiopia

Introduction: Ethiopia has made remarkable progress in expanding access to comprehensive abortion care (CAC). However, complications due to unsafe abortion persist. Evaluating service quality is critical, yet research has mostly focused on accessibility, availability, and meeting clinical criteria, rather than examining quality from abortion clients’ perspectives. This study assesses the quality of comprehensive abortion care in public health facilities, from clients’ perspectives, in four regions of Ethiopia to examine how person-centered care differs based on facility and service characteristics. Methods: We conducted 1,870 client exit surveys in 2018 using structured questionnaires with women who received induced abortion or postabortion care services from 76 public health facilities across four regions: Tigray, Amhara, Oromia, and Southern Nations, Nationalities, and People’s. We operationalized person-centered care by mapping 30 indicators of quality to five of the six domains in the Person-Centered Care Framework for Reproductive Health Equity developed by Sudhinaraset and colleagues (2017): dignity & respect; autonomy; communication & supportive care; trust, privacy, and confidentiality; and health facility environment. We calculated descriptive, bivariate, and multivariable statistics to examine associations between service characteristics and person-centered care. Results: CAC clients reported high levels of person-centered care, with exceptionally positive experiences for outcomes in the dignity and respect and trust, privacy, and confidentiality domains. We identified room for improvement across three domains: autonomy, communication and supportive care, and health facility environment. Client-reported quality outcomes differed significantly by diagnosis (induced or postabortion care), region, health facility type, and procedure type. Clients in Amhara, clients at tertiary and primary hospitals, and clients who received postabortion care reported lower quality person-centered care. Discussion: The positive experiences reported by CAC clients bolster evidence of the impact of the Ethiopian government’s strategy to increase abortion access in the public health sector. Notable disparities exist for those seeking postabortion care and people visiting tertiary and primary hospitals. Quality improvement efforts should focus on clients' autonomy, communication and supportive care, and the health facility environment. The Ethiopian Ministry of Health and its partners must prioritize postabortion care quality, integration of reproductive health services within CAC, and pain management for MA clients as vital interventions.